D&C: Dilation and Curettage
D&C stands for Dilation (or Dilatation) and Curettage, a surgical procedure involving the dilation of the cervix followed by scraping of the uterine lining with a curette. 1, 2
Procedure Components
- Dilation refers to the opening or widening of the cervix to allow access to the uterine cavity 1
- Curettage is the process of scraping away tissue from the uterine lining using a sharp curette instrument 1, 2
Clinical Context and Limitations
- D&C has historically been considered the standard method for obtaining endometrial tissue samples for histologic examination, though the scientific basis for this assumption has been questioned 2
- The procedure is widely used for diagnostic purposes in cases of abnormal uterine bleeding, but studies show it has significant limitations in diagnostic accuracy 2, 3
- D&C failed to detect intrauterine disorders in 62.5% of cases when compared to subsequent hysterectomy findings, with a sensitivity of only 46% 3
- The tissue yield and diagnostic accuracy of D&C have not been adequately evaluated despite its extensive use 2
Important Caveats
- D&C carries risks including uterine perforation (particularly in postpartum women less than 15 weeks postpartum), bleeding requiring readmission, and potential complications 4
- The procedure costs approach one billion dollars per year in the United States alone, raising questions about cost-effectiveness 2
- Newer diagnostic procedures such as Vabra aspiration may be safer, less expensive, and more convenient alternatives 2
- In asymptomatic women under age 35, diagnostic D&C yields minimal clinically significant findings and may not be warranted 4, 5